Sleep Apnea Quiz

Do you believe you might be suffering from undiagnosed sleep apnea?

Take our quiz to find out more information. After you submit the quiz, we will be in touch shortly.

Name:

Email:

Phone Number:

Age:

Weight:

Gender:

Have you ever had an evaluation at a sleep center?:

Yes

Do you have a CPAP device?:

Yes

Have you ever attempted sleep/snoring therapy?:

Yes

If yes, please provide details:

Sitting and reading:

Watching TV:

Sitting in a public place (e.g.: theatre, meeting or church):

As a passenger in a car for an hour without a break:

Lying down to rest in the afternoon when circumstances permit:

Sitting and talking to someone:

Sitting quietly after lunch without alcohol:

In a car, while stopped for a few minutes in traffic:

Ready for your restless nights to stop?